Unit 7 - Carb disorders Flashcards
__ glucose levels incompatible with life
Very Low
Is high blood glucose fatal?
No, but causes damage/disease
Lactose intolerance symptoms
Diarrhea
Gas
Bloating
Can lactose itself be absorbed?
Not without being broken down because it is a disaccharide
Why does lactose intolerance cause those symptoms?
Lactose fermenters in GI metabolize it and cause gas and excess metabolites cause diarrhea
What is lactose broken down into?
Galactose and glucose
What breaks down lactose?
Intestinal Lactase Phlorizin Hydrolase
Lactase (beta galactosidase)
Is lactase persistence normal?
No, only in mutated populations that domesticated cows
3 forms of lactose intolerance
Congenital
Primary
Secondary
Congenital lactose intolerance
Genetic absence of lactase (v.v. rare)
When is congenital lactose intolerance detected?
Immediately because of failure to thrive
How prevalent is Primary lactose intolerance
Majority of lactose intolerances
What is primary lactose intolerance
Lactase that doesn’t persist past infancy
What percent of normal lactase level is needed to be asymptomatic?
50%
What is secondary lactose intolerance
Intestinal disease diminishes lactase
Treatable by treating underlying condition
What is galactosemia
Lactose = glucose + galactose
Galactose can’t be converted
Absence of one of 3 enzyme req. to metabolize galactose
What builds up in galactosemia?
Galactose and metabolites
How severe is galactosemia?
75% mortality without treatment
What does galactosemia cause?
Liver disease - hepatomegaly, cirrhosis
Cataracts
Brain damage
Kidney damage
Hypoglycemia
How does excess human GH affect glucose?
Glucose intolerance
Bone & Tissue Growth issues
Two forms of excess GH
Child - Pituitary gigantism
Adult - Acromegaly
What causes excess GH?
Most common - Pituitary tumor
Pheochromocytoma
Tumor of adrenal medulla
What does pheochromocytoma produce?
Epinephrine/adrenaline
What is a result of pheochromocytoma
Hyperglycemia
Rapid heartbeat
High blood pressure
Glucose intolerance associated with
Cortisol excess
Hyperthyroidism
A goiter and exophtalmopathy is present as well as glucose intolerance, what could this be?
Hyperthyroidism
Hyperglycemia needs to be followed up with
A full endocrine workup
Hypoglycemia blood glucose levels
<50 mg/dL
Signs/Symptoms of hypoglycemia
Neurologic issues - Tremors, blurred vision, headache, fatigue, etc
Hunger
Rapid pulse
Normal newborn glucose
35 mg/dL
Whipple’s Triad for Hypoglycemia
Signs/Symptoms
Low plasma glucose
Relief of s/s with glucose administration
Best way to diagnosis hypoglycemia?
72 hour fast with levels of glucose, insulin, proinsulin, and C-peptide drawn every 6 hours
What level are low in artificial insulin overdose?
C-peptide should be low with increased insulin
Insulinoma
High insulin, High C peptide
Low Glucose
High Insulin
High C-peptide
Insulinoma
Low Glucose
High Insulin
Low C-peptide
Insulin admin with Ab cross reactivity
Low glucose
Low Insulin
Low C-peptide
Insulin admin without AB cross reactivity
Diabetes in Green
To pass through
Diabetes Insipidus - Taste
Bland, no taste urine
Diabetes Mellitis - Taste
Honey, sweet tasting urine
Diabetes Mellitus
Loss of glucose tolerance
Diabetics have on average ___ times the healthcare costs
2.3 times
More people die of __ than breast cancer and aids in the US
Diabetes Melitus than breast cancer and aids combined
Type 1 DM
Lack of insulin (5-10%)
Type 2 DM
Insulin resistance (90-95%)
Gestational Diabetes
Resolves when pregnancy complete (7% all pregnancies)
What can cause no insulin synthesis in Type I DM
Autoantibodies
Autoimmunity against beta cells
Pancreatic disease
What can cause insulin resistance in Type 2 DM
Type A - Obesity
Type B - Ab to insulin receptors
Impaired glucose transport
Patient has hyperglycemia and increased urine volume, what should this be?
Type 1 or Type 2 DM
Patient has hyperglycemia and increased thirst, what should this be?
Type 1 or Type 2 DM
Patient has hyperglycemia with appetite and weight loss, what should this be?
Type 1 DM
Patient has hyperglycemia with obesity and weight gain, what could this be?
Type 2 DM
Patient has hyperglycemia with recurrent infection, UTI, and vaginitis what could this be?
Type 2 DM
Which type of diabetes is associated with metabolic acidosis?
Type 1
Diabetic ketoacidosis is associated with what type of DM?
Type 1
Acanthuses nigricans
Darkening in skin folds because of insulin resistance in Type 2 DM
Hyperglycemic hyperosmolar non-ketotic coma
High Glucose
Low pH
No ketoacids produced
Diabetic ketoacidosis
Low blood pH
Metabolic acidosis
High anion gap
Low bicarb
What causes metabolic acidosis in Type I DM
Production of ketoacids because body isn’t producing carbs cuz of no glucose
